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Radiation & Recurrence Treatment (Inside & Outside Prostate)
So a big part of my decision on radiation vs surgery is based on odds of recurrence as I know salvage is more complicated after radiation. (Diagnosed as 3+4 with 10% in 2 areas on one side of the prostate with no cribiform, intraductal and clean PMSA Pet.)
Chat GPT ( know it has limitations) estimates that out of 100 men with my profile 4 men on average will have recurrence locally and 6 men will have recurrence outside the prostate bed. From what I’ve read ….treatment is the same when recurrence is outside the prostate regardless of whether you initially had surgery or radiation.
Assuming these numbers are accurate ( or at least in the ballpark) there’s only a 4% chance ( 4 out 100 men) where salvage treatment would be different ( and admittedly more complicated) if I initially chose radiation vs surgery.
Assuming this is accurate this makes me lean towards radiation…Does this make sense…..am I making this too simplistic?
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@jeffmarc
Proton therapy is not considered experimental, it has been around for 50+ years. It is not specialized either as it has been used on many different types of cancer. Just another tool to use in the cancer fight. A lot of the larger hospitals in any state should have access to a Proton machine.
Dave 3+4
@clevelandguy
That comment was not about proton therapy in general since it’s been around so long.
It was specifically referencing using proton therapy for retreatment of areas that had already been radiated.
@jeffmarc
That’s not true either, it been used for years after traditional x-ray type radiation has maxed out an area.
Dave 3+4
@clevelandguy
You may say this Has been used for years, But it appears that it is very rare.
I attend nine prostate cancer meetings every month. I’ve been attending nine for about two years and I have attended four weekly meetings for about five years with one group. I’ve been coming to the Mayo Clinic daily for almost 2 years. Six of those monthly meetings are just advanced cases.
I have never heard of anybody saying they had proton radiation to an area that had already been treated with a lifetime dose of radiation to a prostate or any other area. One of the online groups I go to weekly has almost 50 people show up every week, This week there were three brand new people annd about 10 others that wanted to talk about their current cases. No one mentioned having proton to an existing area, Never heard of it before from anyone.
It may be occurring in some places, but it is rare to put it mildly and from what I have read it is experimental. Hard to say what the long-term consequences are.
@clevelandguy
Also in your comment about waiting several years I guess after xray based radiation before you can use Proton if that is what you are referring to is also not true. As soon as a few weeks after xray has maxed out an area you can use Proton technology. The 3-4 weeks is usually to do more MRI mapping required to pinpoint the area.
Dave 3+4
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1 Reaction@clevelandguy
A search of AI said that this is true. Considering I’ve never heard anybody even having it I can’t say what is really true.
@jeffmarc
Not saying it’s used every day or every month. The point is it CAN be done. You say you don’t know of anyone that has used it, so be it but it can be used, it’s not experimental. The long term outlook is the same as any other form of external beam radiation. Just another tool to put in the tool box if you need it.
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1 Reaction@clevelandguy
Search of the web says it’s in trial. I have a suspicion that it is not been used by a lot of people since I’ve never heard of anybody having it. When they start doing something like that, they evaluate how well it’s working for quite a long time since it takes many years for the side effects to occur.
Yes, researchers are actively studying the use of proton beam re-irradiation (sometimes called salvage proton therapy) for patients who have experienced a recurrence of prostate cancer after receiving a "lifetime" dose of prior radiation therapy (such as external beam radiation therapy, or EBRT).This approach is considered a promising option for treating local recurrences while minimizing damage to healthy tissues that were already exposed to radiation.
Here’s a couple of articles about it.
https://www.nyproton.com/how-proton-therapy-is-transforming-treatment-for-recurrent-cancer/.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10870390/.
There’s a lot more information about the studies, but the recommendation is for specific, up-to-date trials, it is recommended to search on ClinicalTrials.gov using keywords such as "prostate cancer," "re-irradiation," and "proton."
“Search of the web says it’s in trial.” That’s not really accurate. Proton had been used as a salvage radiation tool after conventional radiation for many years. Never saw reading the studies you referenced where it said it was “in trail” or more trials are still needed. It’s a current valid method that is being used today.
Dave 3+4
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1 Reaction@clevelandguy
You say it’s been used for many years, but the people I constantly hear from don’t seem to Corroborate that. Like I say, I have never heard of it being used, And I am seeing and hearing from people constantly, that are talking about their treatments. Do a search for it in this forum. I don’t think you will hear of one case, if it’s so much used, then you sure should hear about it.
It would take many years of evaluation before they know what the real long-term side effects are of doing radiation over what was referred to as maximum lifetime dose of IMRT or SBRT.
Do you personally know people that have had this treatment?